Friday, March 16, 2012

simple home test may predict risk for vascular disease



This article abstract below reviews the benefits of checking Blood Pressure in your Right and Left arm and using the information to evaluate risk for vascular disease.

This is an easy inexpensive test that can be done at home or in your doctors office.

Their analysis 
 a difference of systolic Blood pressure  between the Right and left arm of;

 * 10 was associated with increased risk of peripheral vascular disease ( arteries in the legs and feet)

 *15 or more is associated with increased risk of peripheral vascular disease, preexisting  
   cerebral vascular  and cardiovascular disease


Their Interpretation
"A difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death."


Comment
This easy test is another tool that can help us be more comfortable with our current treatment program or may encourage us to have further vascular assessment and to become more aggressive with our lipid and blood pressure management.



The Lancet Volume 379, issue9819,  page 905-910 , 10 March 2012
Association of a difference in systolic blood pressure between arms with vascular disease and mortality: Review and meta- analysis

Have Fun, be Smart and Defeat Diabetes
David Calder,MD



The Lancet, Volume 379, Issue 9819, Pages 905 - 914, 10 March 2012
doi:10.1016/S0140-6736(11)61710-8Cite or Link Using DOI
Published Online: 30 January 2012

Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis

Dr Christopher E Clark FRCP a Corresponding AuthorEmail AddressPhD Rod S Taylor Prof aProf Angela C Shore PhD bObioha C Ukoumunne PhD cProf John L Campbell MD a

Summary

Background

Differences in systolic blood pressure (SBP) of 10 mm Hg or more or 15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. We investigated whether an association exists between this difference and central or peripheral vascular disease, and mortality.

Methods

We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, and Medline In Process databases for studies published before July, 2011, showing differences in SBP between arms, with data for subclavian stenosis, peripheral vascular disease, cerebrovascular disease, cardiovascular disease, or survival. We used random effects meta-analysis to combine estimates of the association between differences in SBP between arms and each outcome.

Findings

We identified 28 eligible studies for review, 20 of which were included in our meta-analyses. In five invasive studies using angiography, mean difference in SBP between arms was 36·9 mm Hg (95% CI 35·4—38·4) for proven subclavian stenosis (>50% occlusion), and a difference of 10 mm Hg or more was strongly associated with subclavian stenosis (risk ratio [RR] 8·8, 95% CI 3·6—21·2). In non-invasive studies, pooled findings showed that a difference of 15 mm Hg or more was associated with peripheral vascular disease (nine cohorts; RR 2·5, 95% CI 1·6—3·8; sensitivity 15%, 9—23; specificity 96%, 94—98); pre-existing cerebrovascular disease (five cohorts; RR 1·6, 1·1—2·4; sensitivity 8%, 2—26; specificity 93%, 86—97); and increased cardiovascular mortality (four cohorts; hazard ratio [HR] 1·7, 95% CI 1·1—2·5) and all-cause mortality (HR 1·6, 1·1—2·3). A difference of 10 mm Hg or higher was associated with peripheral vascular disease (five studies; RR 2·4, 1·5—3·9; sensitivity 32%, 23—41; specificity 91%, 86—94).

Interpretation

A difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death.

Funding

Royal College of General Practitioners, South West GP Trust, and Peninsula Collaboration for Leadership in Applied Health Research and Care.

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Your comments and questions are appreciated. David Calder,MD